急性下肢近端深静脉血栓导管溶栓期间抗凝选择的研究进展  

Research progress of anticoagulant selection during thrombolysis of acute proximal deep vein thrombosis of lower extremity

作　　者：刘勇君 王勇志 陈一 张祖森 肖乐[2] Liu Yongjun;Wang Yongzhi;Chen Yi;Zhang Zusen;Xiao Le(Department of Vascular Surgery,the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650500,Yunnan,China;Department of Vascular Surgery,the First People's Hospital of Yunnan Province,Kunming 650032,Yunnan,China)

机构地区：[1]昆明理工大学附属医院血管外科,云南昆明650500 [2]云南省第一人民医院血管外科,云南昆明650032

出　　处：《血管与腔内血管外科杂志》2025年第3期355-359,共5页Journal of Vascular and Endovascular Surgery

基　　金：云南省老年临床医学中心开放课题(2022YJZX-LN12)。

摘　　要：急性下肢近端深静脉血栓(DVT)的发病率高,危害性大,尽管治疗的方法很多,但抗凝和溶栓仍是目前临床上最常用的治疗手段,其安全性和有效性已得到临床认可和国内外指南的推荐。有效的抗凝治疗能够抑制血栓蔓延,预防复发;及时的溶栓能够有效清除血栓、解除梗阻,降低血栓后综合征的发生率。导管接触溶栓(CDT)是目前临床首选的溶栓方法,但是,关于CDT期间不同抗凝方案效果比较的研究鲜有报道,对于CDT期间最佳的抗凝方案亦尚未达成共识,国内外指南也无具体推荐,在临床实践工作中,各中心在CDT期间的抗凝选择也不尽相同,包括普通肝素、低分子肝素(LMWH)、新型口服抗凝药物和磺达肝癸钠。因此,为了更加安全、有效地开展下肢深静脉血栓CDT期间的抗凝药物治疗,本文结合相关文献和指南进行综述。Acute proximal deep vein thrombosis(DVT)of lower extremity has a high prevalence and high risk.Although there are many treatment methods,anticoagulation and thrombolysis are still the most commonly used treatments in clinical practice,and the safety and efficacy have been clinically recognized and recommended by domestic and international guidelines.Effective anticoagulation therapy can inhibit the spread of thrombus and prevent recurrence.Meanwhile,timely thrombolysis can effectively remove the thrombus,release the obstruction,and reduce the incidence of post-thrombotic syndrome.Catheter-directed thrombolysis(CDT)is currently the preferred method of thrombolysis,but comparative studies between anticoagulants during CDT are rarely reported in the available literature,there is no consensus on the optimal anticoagulation scheme in thrombolysis,and there are no specific recommendations in domestic and international guidelines.In clinical practice,the choice of anticoagulation during CDT varies among centers,including unfractionated heparin,low molecular weight heparin(LMWH),new oral anticoagulants,and fondaparinux.Therefore,this paper reviews the relevant literature and guidelines in order to carry out the anticoagulation treatment of lower extremity deep vein thrombosis(DVT)during CDT more safely and effectively.

关 键 词：急性下肢深静脉形成 导管溶栓治疗 抗凝治疗 肝素类药物 新型口服抗凝药物 利伐沙班 

分 类 号：R543[医药卫生—心血管疾病]